Single Use, Disposable Uterine Manipulator and Method of Use

ABSTRACT

The present invention relates to single use, disposable, uterine manipulator device and methods for use thereof. The device comprises a tubular elongate portion defining a longitudinal axis of the device, and having a proximal and a distal extremity, wherein the distal extremity is provided with sealing abutment means for sealingly abutting the cervix, and the distal extremity is further provided with uterine wall suction means distributed around the distal extremity for providing suction to the device, thereby enabling said device to come into suction contact with an inner uterine wall.

The present invention relates to single use, disposable surgicalinstruments in general, and more particularly to a device formanipulating a uterus that is particularly adapted to use incoelioscopic surgery.

One of the current problems encountered in coelioscopic surgery infemale patients is the position that the female reproductive organs, andin particular the uterus, the fallopian tubes and ovaries, adopt becauseof the way the patient is laid out on the operating table. Thisposition, know as the Trendelebourg position, causes the femalereproductive organs to fall back into the Douglas' pouch or rectouterineexcavation, thereby making access to that pouch difficult or impossiblefor the surgeon. Several attempts have been made to produce devices thatwould assist the surgeon in gaining access to the Douglas' pouch moreeasily, most of which involve inflicting some kind of trauma on thefemale reproductive organs.

For example, one known device comprises a frustoconical screw-threadedplug that is screwed into the cervix of the female patient, in order topermit manipulation of the uterus, and thereby enable the surgeon toposition the uterus as desired during surgery. The problem with a devicesuch as this is that the screw thread bites into the cervical wall, andinevitably causes a certain degree of trauma. It has been noticed ingeneral that trauma to the cervical wall, in whatever form, can lead toreduced fertility, especially in younger female subjects, and so itwould be desirable to avoid, where possible, inflicting any such trauma.

Another example of a device for uterine manipulation involves aninflatable balloon, that is provided at a distal tip of a manipulator.The manipulator is inserted into the uterus via the vagina, and theballoon inflated so that the exterior walls of the balloon come intopressure contact with the inner walls of the uterus. The idea is thatthe expansion of the balloon causes sufficient friction against theinner uterine wall to enable the surgeon to operate the manipulator andthereby displace the uterus in the desired direction. However, in orderto be effective, the device must generally be inserted into the uterusuntil it meets with the upper inner wall of the latter, and then theballoon inflated, and the pressure thereby exerted by the balloon cancause localised damage to the uterine inner wall.

The device according to the present invention attempts to overcome theabove limitations, whilst at the same time being easy to use andoperate, and most notably, being atraumatic, i.e. not inflicting traumaon the inner wall of the uterus or the cervical wall.

Accordingly, one object of the present invention is a single use,disposable uterine manipulator device, comprising:

a tubular elongate portion defining a longitudinal axis of the device,and having a proximal and a distal extremity;

wherein the distal extremity is provided with sealing abutment means forsealingly abutting the cervix, and the distal extremity is furtherprovided with uterine wall suction means distributed around the distalextremity for providing suction to the device, thereby enabling saiddevice to come into suction contact with an inner uterine wall.

Preferably, the tubular elongate portion is made of a sterilisablematerial, preferably stainless steel, however other materials may alsoprovide satisfaction, provided that they are suitable for use in asurgical instrument, are suitably rigid and can be sterilised.

In one preferred embodiment, the sealing abutment means and the uterinewall suction means are formed integrally as a sleeve that fits over thedistal extremity of the tubular elongate portion. It is of coursepossible to envisage that the sealing abutment means and the uterinewall suction means be separate elements mounted on the tubular elongateportion such that they perform their function appropriately.

Preferably, the sleeve of the uterine wall suction means is made of asterilisable polymer material, and even more preferably of a polymermaterial selected from the group consisting of polyoxymethacrylate,polyacetal, and PA66.

In accordance with another preferred embodiment, the tubular elongateportion is open at the distal extremity and together with an innersurface of the sleeve mentioned above defines a space allowing for thepassage of fluid. The passage of fluid can be simply formed by providingfor a difference in diameter between the outside diameter of the tubularelongate portion and the inner diameter of the sleeve, and leaving thedistal extremity of the tubular elongate portion free or unblocked, suchthat fluids may pass either into the distal extremity of the elongateportion, for example, air being withdrawn under vacuum, or in theopposite direction, for example, when a liquid, such as a contrast orwashing agent, is injected from the proximal end of the tubular elongateportion.

The sleeve also preferably comprises a plurality of suction orificeswhich traverse a wall of the sleeve and communicate with the spaceallowing for passage of fluid. Thes plurality of orifices is even morepreferably distributed about the sleeve in a manner enabling asufficient portion of the sleeve to come into suction contact with aninner uterine wall. Thus the plurality of orifices forms, along with thespace created between the sleeve and elongate tubular portion, a way ofcreating fluid communication between an inner wall of the uterus, andthe outside environment, i.e. the environment outside of the uterus.

Where fluid communication to be created is in the form of vacuum orsuction, such suction is preferably provided at a vacuum pressurecomprised between 0.4 bar and 0.8 bar, and most preferably is about 0.6bar. The applicant has noticed that this latter value is completelyatraumatic for the tissue of the uterus, including the inner walls ofthe uterus to which the device becomes attached when vacuum or suctionis applied through the device.

Even more preferably, the device sleeve comprises a total of 8, or mostpreferably 10 orifices, distributed evenly about the sleeve in a 3-2-3,or respectively, a 3-2-3-2 configuration. Such a configuration allowsfor optimal coverage of the inner uterine wall surfaces, therebyfacilitating manipulation of the uterus when vacuum is being applied.

It will be understood from the above, that the sleeve can preferablyhave a section that widens from a proximal end towards a distal end ofsaid sleeve.

The sealing abutment means are designed to abut, in a sealing manner,the cervix, and thus it is preferred that they be located at a proximalend of the sleeve, and have a section that is substantially conical,adapted in shape and size to sealingly abut a cervix, and extending froma widened proximal end to a narrowed distal end which abuts or adjoinsthe proximal end of the sleeve. It is to be noted that since the sealingabutment means are substantially conical, the nose or distal end formedthereby can preferably be snubbed or rounded, to enable a less traumaticcontact with the cervix. One should note here the complete contrast withprior art solutions involving a screw thread which engages the tissue ofthe cervix and can cause damage thereto.

In one advantageous embodiment, the device further preferably comprisesgrip means, mounted in axial sliding engagement around the tubularelongate portion, proximal to the uterine wall suction means and sealingabutment means, and distal to the proximal extremity of the tubularelongate portion. Preferably, the grip means are mounted in fixedrotating engagement about the tubular elongate portion, but they canalso be made to rotate in and out of a locked position, should that bedesired. It can thus be seen that the tubular elongate portion bearingthe uterine wall suction means can slide along inside the grip means,while leaving an exterior grip surface free for the surgeon tomanipulate the device, for example, rotating it in one direction oranother.

Even more preferably, the device also comprises a Luer lock 2-way valvelocated at the proximal extremity the tubular elongate portion. Such a2-way Luer lock preferable provides:

in a first open position, for a fluid communication between the elongatetubular portion and the uterine wall suction means,

in a second position, for complete obstruction of the Luer lock.

In still yet another preferred embodiment, the device further compriseshysterectomy guide means. These guide means are used to aid the surgeonin performing a hysterectomy, either a sub-total hysterectomy or a totalhysterectomy, depending on how much of the cervix is removed along withthe uterus. Preferably, the hysterectomy guide means comprises anadapter comprising engagement means to engage the proximal end of thesealing abutment means, and ablation guide sleeve which is adapted toengage at least partially circumferentially an exterior wall of thecervix. Even more preferably, the adapter has clips means for removablyengaging a proximal surface of the sealing abutment means. It can thusbe seen that the adapter slides over the sealing abutment means and canbe clipped and retained at a proximal end of the sealing abutment means.Where the adapter is made of resilient or slightly elastic material, itis preferably designed to elastically fit over the substantially conicalsealing abutment means and then snap back over a proximal circumferenceor periphery of said sealing abutment means.

As a result, it is preferred that the adapter also be substantiallyconical in shape, extending from a widened proximal end towards anarrowed distal end, the shape defined thereby enabling sealing abutmentof the adapter with an inner vaginal wall. Thus, the initial cervicalsealing abutment means no longer serve their purpose, since they arecovered, in this particular embodiment, by the adapter, which isdimensioned to provide sealing abutment with an inner vaginal wall andnot the cervix.

In a further preferred embodiment, the ablation guide sleeve issubstantially tubular, in order to be able to be slid over the device asdescribed initially, but also comprises a peripheral projecting wall,which extends from a proximal end in abutment with the distal end of theadapter, towards a distal end, wherein the projecting wall engages atpartially circumferentially an exterior wall of the cervix. In this way,the projecting wall serves as a guide for the surgeon as to where thetissue of the cervix should be sectioned and removed along with the restof the uterus.

In still yet another object of the invention, there is provided a methodof manipulating an inner wall of a uterus, comprising the stepsconsisting of:

inserting a uterine manipulator device comprising a tubular elongateportion defining a longitudinal axis of the device, and having aproximal and a distal extremity, wherein the distal extremity isprovided with sealing abutment means for sealingly abutting the cervix,and the distal extremity is further provided with uterine wall suctionmeans distributed around the distal extremity for providing suction tothe device;

applying suction vacuum pressure to the device to activate suction viathe uterine wall suction means, thereby enabling said device to comeinto suction contact with an inner uterine wall;

moving the device into a desired position, whereby the suction appliedvia the uterine wall suction means causes the uterus to be movedcorrespondingly with the device.

The invention also provides for a method for performing a contrastdiagnostic test in a female reproductive organ, comprising the stepsconsisting of:

introducing a uterine manipulation device as described above into auterus to obtain sealing abutment of the device with a cervix;

setting a Luer lock on the uterine manipulator device to a positionwhereby vacuum suction communication is obstructed and yet stillallowing another fluid to be introduced into said device; and

introducing via said Luer lock a contrast agent that flows through thedevice and into the uterus.

In addition, still yet another preferred object is a method forperforming a hysterectomy, comprising the steps consisting of:

introducing a device as described above into a uterus, whereby anadapter comes into sealing abutment with an inner vaginal wall, and aablation guide sleeve comes into at least a partial circumferentialengagement with an exterior wall of a cervix;

using a distal extremity of the ablation guide sleeve as a guide todetermine the limit of ablation of said uterus.

Other objects and preferred embodiments will become apparent through thedetailed description and the figures, given purely for illustrativepurposes, as follows :

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is schematic represenation of a single use, disposable, uterinemanipulation device according to the present invention;

FIGS. 2 a, 2 b and 2 c are different schematic views of a distal part ofthe uterine manipulation device illustrated in FIG. 1;

FIG. 3 is a first representation of the introduction into a uterus ofthe device of FIG. 1;

FIG. 4 is a second representation of the normal final position of thedevice of FIG 1 once fully introduced into the uterus;

FIGS. 5 a, 5 b and 5 c are different schematic representations of afurther adapter for the device of the present invention;

FIG. 6 is a schematic representation of an extra component that fitsonto the adapter illustrated in FIG. 5, and which is suited to assistinga surgeon in carrying out a hysterectomy.

EXAMPLES, OR DETAILED DESCRIPTION OF THE INVENTION

As can be seen from FIG. 1, the single use, disposable, uterinemanipulation device, indicated by the general reference 1, comprises atubular elongate portion, identified by the general reference 2,defining a longitudinal axis 3 of the device 1, and having a proximal 4and a distal extremity 5. The distal extremity 5 is provided withsealing abutment means, indicated generally by the reference 6, forsealingly abutting a cervix 7 (cf. FIGS. 3 and 4), and the distalextremity 5 is further provided with uterine wall suction means 8distributed around the distal extremity 5 for providing suction to thedevice 1, thereby enabling the device 1 to come into suction contactwith an inner uterine wall 9. The tubular elongate portion 2 is made ofa sterilisable, surgically appropriate material, preferably stainlesssteel, and thus generally takes the shape of a stainless steel tube 10.The tube 10 is essentially hollow along the axis 3 and has an opening atboth the proximal 4 and distal 5 extremities. FIG. 1 also shows that thedevice 1 further comprises grip means, indicated generally by thereference 11, mounted in axial sliding engagement around the tubularelongate portion 2, proximal to the uterine wall suction means 8 andsealing abutment means 6 and distal to the proximal extremity 4 of thetubular elongate portion 2. The grip means 11 are mounted in fixedrotating engagement about the tubular elongate portion 2. As can be seenfrom FIG. 1, the grip means II comprise a fairly large outer diametertube 12. The tube can optionally be provided with ridges, notillustrated in the figure, to facilitate prehension by the operator ofthe device 1. The grip means 11 further include an enlarged,approximately funnel-shaped, proximal extremity 13, enabling otherinstruments to be introduced into the tube 12 if necessary. Since thegrip means 11 are rotatively, but not slidingly locked, about the axis 3of the device, it is posssible to manipulate the device by rotating thetube 12 about said axis. It is furthermore possible to slide the sealingabutment means 6 and uterine wall suction means 8 along the axis 3 tointroduce the latter into, and out of, the vagina 14 towards the uterus15. The proximal extremity 4 of the device 1 is connected to a fluidcommunication conduit 16. The conduit 16 is made of a flexible fluidimpermeable polymer material, of the type commonly used in hospitals orother surgical devices for the passage of fluids, be they liquids orgases. The fluid communication conduit 16 is connected to a Luer lockvalve 17, having two ports 18,19. A first port 18 is connected to avacuum generator device or apparatus (not shown), for establishingvacuum or suction, such that air is sucked in via the uterine wallsuction means 8, through the distal extremity 5 of the device 1, andthen along the tubular elongate portion 2 and through the conduit 16 andfirst port 18. A second port 19 is provided for introduction and removalof another fluid, for example, a contrast agent such as methylene blue,which can be injected as a liquid through the second port 19 and intothe uterus 15 via the device 1 by following the same schema as above,but in a reverse direction. The 2-way Luer lock valve 17 thus provides,in a first open position, for a fluid communication between the elongatetubular portion 2 and the uterine wall suction means 8, and in a secondposition, for complete obstruction of the Luer lock 17. The 2 Luer lockvalve 17 thus also comprises a switch or lever 20, which can beactivated to set the lock in a desired position, depending on whetherthe operator of the device 1 wants the fluid communication to be vacuumor suction in the first case, fluid communication for the introductionof a contrast agent, in a second case, and of course a third position,whereby all fluid communication is obstructed. In order to facilitaterecognition of the position in which the lock 17 is set, the lock can beprovided with markings 21, arranged on the lever 20, and indexedtherewith.

As can be seen in more detail from FIG. 2, the sealing abutment means 6and the uterine wall suction means 8 are formed integrally as a sleeve32 that fits over the distal extremity 5 of the tubular elongate portion2. FIG. 2 a shows a cross-section of the sleeve 32, along axis 3 of thedevice, clearly showing that the sleeve is hollow, and has an outer wall22 and inner wall 23, defining an inner bore or space 24. The distal end25 of the sleeve is blind, i.e. closed, and the distal limit 26 of thebore or space 24 has a generally concave shape, such that a distal endof the stainless steel tube 10 does not sealingly abut said limit 26,thereby allowing for passage of fluid between an opening in the distalend of the tube JO, and the space 24 of the sleeve. Additionally, as canbe seen from FIG. 2 b, the sleeve does not have a circularcross-section, but extends from proximal end 27 towards the distal end25 of the sleeve in a slightly widening cross-section, thereby ensuringthat a fluid communication space 24 will be created between thestainless steel tube 10 and the inner wall 23 of the sleeve 32, and thatthe tube 10 will be held in elastic sealing engagement with the proximalend 27. The sealing abutment means 6 are located at a proximal end 27 ofthe sleeve 32, and has a cross-section susbtantially forming a cone 28,adapted in shape and size to sealingly abut a cervix. The cone 28extends from a widened proximal end 29 to a narrowed distal end 30 whichabuts or adjoins the sleeve 32. The uterine wall suction means 8 alsocomprise a plurality of orifices 31, distributed evenly around thesleeve 32, preferably in a 3-2-3-2 configuration or arrangement, as canbe seen partially from FIG. 2 c. The orifices 31 traverse the outer andinner walls 22, 23 of the sleeve, and open into the fluid communicationspace 24. Thus, when vacuum is applied via the Luer lock port 18, air iswithdrawn from within the device and a depression created that causes auterine wall 9 to be sucked onto the sleeve 32. In a converse manner,when fluid, such as a contrast agent, is introduced via port 19, saidfluid can pass through the device, into the space 24 and through theorifices into the uterus 15. As the cone sealingly abuts the cervix 7 ofthe uterus 15, no leakage in the sealtight environment can occur, andthus the vacuum pressure is maintained, or respectively, the fluidintroduced into the uterus 15 remains therein or will permeate throughthe tissues therein or other organs connected thereto.

Turning now to FIG. 3, one can see a schematic representation of femalehuman reproductive organs, indicated by the general reference 33. Theseorgans are represented generally by the ovaries 34, 35, the fallopiantubes 36, 37, the uterine cavity 38, the cervix 7, the uterine isthmus40, and the vagina 14. The vagina 14 and uterus are shown here o theright hand side a in partial cut-away representation, in order to showthe uterine cavity 38 and inner 39 and outer vaginal 41 walls and inneruterine 9 walls. In FIG. 3, one can see that the device has beenintroduced via the vagina 14 and the cervix into the uterus 14, suchthat the distal end 25 of the sleeve 32 has reached the uterine isthmus40. In this position, the device 1 of the invention is not yet ready foruse.

FIG. 4 shows, in a schematic representation, the position of the device1 of the invention, once introduction thereof into the uterus 15 hasbeen completed. In this figure, it can be seen that the distal end 30 ofthe cone 28 of the sealing abutment means has come into sealing abutmentengagement with the cervix 7, forming a substantially leaktight seal.One will also note that the sleeve 32 has now been pushed past theuterine isthmus 40, such that the distal end 25 of the sleeve 32 islocated in the uterine cavity 38. The plurality of orifices 31 of thesuction means 8 are now in physical contact with an inner uterine wall9. In FIG. 4, the Luer lock port 18 is shown in the closed position, butwhen the lever 20 is moved and set to the open position, i.e. in thisparticular example by turning the lever through 90 degrees so that itlies over the second port 19, then vacuum pressure that can be appliedwill suck out any air in the device, creating a depression in the space24 between the inner wall of the sleeve 32 and stainless steel tube andthereby causing a drop in pressure at the orifices 31, which in turnwill cause the inner uterine wall 9 to be sucked onto the outer wall 22of the sleeve 32. It thus becomes possible to manipulate the uterus 15and associated organs and put them into a position more suitable for thesurgeon, simply by moving the device around in the three-dimensionalanatomical space. In this way, it also makes the Douglas' pouchaccessible to the surgeon, should that be required. The seal ismaintained by the conical shape of the cone 28 which abuts sealinglyagainst the cervix 7, independently of the angle of inclination of thedevice. In a similar maner, a diagnostic test, for example, themethylene blue test, can be carried out very simply by activating thelever 20 again, to set the Luer lock port 18 into the closed position,for example, by either moving the lever 20 forward again by 90 degrees,or by reversing the initial movement. This movement will then open port19, through which the methylen blue contrast agent can be injected. Asthere is a leaktight seal against the cervix 7, none of the fluidintroduced can escape and will therefore diffuse in a classical mannerthrough the various tissues, and particularly up the fallopian tubes tothe ovaries, where the contrast agent will become visible through acoelioscope.

Turning now to FIGS. 5 and 6, these are schematic representations of afurther embodiment of the device of the present invention, in which saiduterine manipulator device 1 can be adapted to guide the surgeon whoneeds to carry out a hysterectomy, be it a total or sub-totalhysterectomy. Consequently, the device 1 further comprises hysterectomyguide means, indicated by the general reference 42 comprises an adapter43 comprising engagement means 44 to engage the proximal end 27 of thesealing abutment means 6, and ablation guide sleeve 45 which is adaptedto engage at least partially circumferentially an exterior wall 46 ofthe cervix 7. The adapter 43 preferably has clip means 47 for removablyengaging a proximal surface 48 of the sealing abutment means 6. In FIG.5, it can be seen that the adapter 43 has lands or cut-outs 49, whichform wings 50 in the adapter 43 and enable it to be slid over the cone28 via the distal end of the sealing abutment means 6. Since the adapteris preferably made of resilient or elastic material, the wings 50 spreadas the adapter 43 is slid over the cone 28 towards the widened proximalend 29 of the latter. The clip means 47, which can for example be one ormore radial flanges 51 provided on the wings 50, then reach over thewidened proximal end 29 of the cone and clip into place on a contactsurface 48 which is essentially the proximal surface of the widenedproximal end 29. Such a clipping action provides for sufficientmaintainance of the adapter 43 in position, whilst at the same timeallowing for its release simply by easing a radial flange back over ontothe cone 28. Consequently, the adapter 43 is preferably substantiallyconical in shape, extending from a widened proximal end 52 towards anarrowed distal end 53, the shape defined thereby enabling sealingabutment of the adapter 43 with an inner vaginal wall 39. The ablationguide sleeve 45 also comprises a peripheral projecting wall 54, whichextends from a proximal end 55 in abutment with the distal end 53 of theadapter 43, towards a distal end 56, wherein the projecting wall 54engages partially circumferentially an exterior wall of the cervix 46.In this way, the projecting wall 54 serves to guide the surgeon wishingto remove the uterus 15 down to a limit on the cervix 7 that is definedby the extent of the projecting peripheral wall 54.

1. A single use, disposable, uterine manipulator device, comprising: atubular elongate portion defining a longitudinal axis of the device, andhaving a proximal and a distal extremity; wherein the distal extremityis provided with sealing abutment means for sealingly abutting a cervix,and the distal extremity is further provided with uterine wall suctionmeans distributed around the distal extremity for providing suction tothe device, thereby enabling said device to come into suction contactwith an inner uterine wall.
 2. A uterine manipulator device according toclaim 1, wherein the tubular elongate portion is made of a sterilisablematerial.
 3. A uterine manipulator device according to claim 1, whereinthe sealing abutment means and the uterine wall suction means are formedintegrally as a sleeve that fits over the distal extremity of thetubular elongate portion.
 4. A uterine manipulator device according toclaim 3, wherein the sleeve is made of a sterilisable polymer material,selected from the group consisting of polyoxymethacrylate, polyacetal,and PA66.
 5. A uterine manipulator device according to claim 1, whereinthe tubular elongate portion is open at the distal extremity andtogether with an inner surface of the sleeve defines a space allowingfor the passage of fluid.
 6. A uterine manipulator device according toclaim 1, wherein the sleeve comprises a plurality of suction orificeswhich traverse a wall of the sleeve and communicate with the spaceallowing for passage of fluid.
 7. A uterine manipulator device accordingto claim 6, wherein the plurality of orifices is distributed about thesleeve in a manner enabling a sufficient portion of the sleeve to comeinto suction contact with an inner uterine wall.
 8. A uterinemanipulator device according to claim 1, wherein the suction is providedat a vacuum pressure between 0.4 bar and 0.8 bar.
 9. A uterinemanipulator device according to claim 1, wherein the sleeve comprises atotal of 10 orifices, distributed evenly about the sleeve in a 3-2-3-2configuration.
 10. A uterine manipulator device according to claim 1,wherein the sleeve has a cross-section that widens from a proximal endtowards a distal end of said sleeve.
 11. A uterine manipulator deviceaccording to claim 1, wherein the sealing abutment means are located ata proximal end of the sleeve, and has a section that is substantiallyconical, adapted in shape and size to sealingly abut a cervix, andextending from a widened proximal end to a narrowed distal end whichabuts or adjoins the sleeve.
 12. A uterine manipulator device accordingto claim 1, wherein the device further comprises grip means, mounted inaxial sliding engagement around the tubular elongate portion, proximalto the uterine wall suction means and sealing abutment means and distalto the proximal extremity of the tubular elongate portion.
 13. A uterinemanipulator device according to claim 1, wherein the grip means aremounted in fixed rotating engagement about the tubular elongate portion.14. A uterine manipulator device according to claim 1, wherein thedevice further comprises a Luer lock 2-way valve located at the proximalextremity the tubular elongate portion.
 15. A uterine manipulator deviceaccording to claim 14, wherein the 2-way Luer lock provides: in a firstopen position, for a fluid communication between the elongate tubularportion and the uterine wall suction means, and in a second position,for complete obstruction of the Luer lock.
 16. A uterine manipulatordevice according to claim 1, wherein the device further compriseshysterectomy guide means.
 17. A uterine manipulation device according toclaim 16, wherein the hysterectomy guide means comprises an adaptercomprising engagement means to engage the proximal end of the sealingabutment means, and an ablation guide sleeve which is adapted to engageat least partially circumferentially an exterior wall of the cervix. 18.A uterine manipulation device according to claim 17, wherein the adapterhas clips means for removably engaging a proximal surface of the sealingabutment means.
 19. A uterine manipulation device according to claim 18,wherein the adapter is substantially conical in shape, extending from awidened proximal end towards a narrowed distal end, the shape definedthereby enabling sealing abutment of the adapter with an inner vaginalwall.
 20. A uterine manipulation device according to claim 16, whereinthe ablation guide sleeve comprises a peripheral projecting wall, whichextends from a proximal end in abutment with the distal end of theadapter, towards a distal end, wherein the projecting wall engagespartially circumferentially an exterior wall of the cervix.
 21. A methodof manipulating an inner wall of a uterus, comprising the steps of:inserting a uterine manipulator device comprising a tubular elongateportion defining a longitudinal axis of the device, and having aproximal and a distal extremity, wherein the distal extremity isprovided with sealing abutment means for sealingly abutting the cervix,and the distal extremity is further provided with uterine wall suctionmeans distributed around the distal extremity for providing suction tothe device; applying suction vacuum pressure to the device to activatesuction via the uterine wall suction means, thereby enabling said deviceto come into suction contact with an inner uterine wall; and moving thedevice into a desired position, whereby the suction applied via theuterine wall suction means causes the uterus to be moved correspondinglywith the device.
 22. A method for performing a contrast diagnostic testin a female reproductive organ, comprising the steps of: introducing auterine manipulation device according to claim 1 into a uterus to obtainsealing abutment of the device with a cervix; setting a 2-way Luer lockon the uterine manipulator device to a position whereby vacuum suctioncommunication is obstructed and yet still allowing another fluid to beintroduced into said device; and introducing via said Luer lock acontrast agent that flows through the device and into the uterus.
 23. Amethod for performing a hysterectomy, comprising the steps of:introducing a device according to claim 1 into a uterus, whereby anadapter comes into sealing abutment with an inner vaginal wall, and anablation guide sleeve comes into at least a partial circumferentialengagement with an exterior wall of a cervix; and using a distalextremity of the ablation guide sleeve as a guide to determine the limitof ablation of said uterus.